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Isozaki T, Ishikawa H, Yasuda S, Isozaki Y, Yamada S, Akutsu Y, Nagata M, Nabeya Y, Minashi K, Murakami K, Kuwano H, Nemoto K, Tsuji H, Uno T, Matsubara H. A Phase I/II Trial of Definitive Carbon Ion Radiotherapy for Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:416-421. [PMID: 37116590 DOI: 10.1016/j.ijrobp.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/26/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Tetsuro Isozaki
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan; Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Hitoshi Ishikawa
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Shigeo Yasuda
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan; Department of Radiology, Chiba Rosai Hospital, Chiba, Japan
| | - Yuka Isozaki
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Shigeru Yamada
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Yasunori Akutsu
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Miwa Central Clinic, Mito, Japan
| | - Matsuo Nagata
- Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan; Department of Surgery, Tojo Hospital, Chiba, Japan
| | - Yoshihiro Nabeya
- Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University, Yamagata, Japan
| | - Hiroshi Tsuji
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology & Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Mangesius J, Hörmandinger K, Jäger R, Skvortsov S, Plankensteiner M, Maffei M, Seppi T, Dejaco D, Santer M, Sarcletti M, Ganswindt U. Chemoradiotherapy Combined with Brachytherapy for the Definitive Treatment of Esophageal Carcinoma. Cancers (Basel) 2023; 15:3594. [PMID: 37509257 PMCID: PMC10377190 DOI: 10.3390/cancers15143594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
This study aims to investigate the effect of dose escalation with brachytherapy (BT) as an addition to definitive chemoradiotherapy (CRT) on local control and survival in esophageal cancer. From 2001 to 2020, 183 patients with locally limited or locally advanced esophageal cancer received definitive CRT with or without brachytherapy in a two-center study. External-beam radiotherapy was delivered at 50.4 Gy in 1.8 Gy daily fractions, followed by a sequential boost to the primary tumor of 9 Gy in 1.8 Gy daily fractions if indicated. Intraluminal high dose rate (HDR) Ir-192 brachytherapy was performed on 71 patients at 10 Gy in two fractions, with one fraction per week. The combined systemic therapy schedules used included 5-fluorouracil/cisplatin or 5-fluorouracil alone. Cisplatin was not administered in patients receiving brachytherapy. The median local progression-free survival was significantly extended in the BT group (18.7 vs. 6.0 months; p < 0.0001), and the median local control was also significantly prolonged (30.5 vs. 11.3 months, p = 0.008). Overall survival (OS) significantly increased in the BT group (median OS 22.7 vs. 9.1 months, p < 0.0001). No significant difference in the overall rate of acute toxicities was observed; however, the rate of acute esophagitis was significantly higher in the BT group (94.4% vs. 81.2%). Likewise, the overall rate of late toxicities (43.7% vs. 18.8%) was significantly higher in the BT group, including the rate of esophageal stenosis (22.5% vs. 9.8%). There was no difference in the occurrence of life-threatening or lethal late toxicities (grades 4 and 5). Brachytherapy, after chemoradiation with single-agent 5-FU, represents a safe and effective alternative for dose escalation in the definitive treatment of esophageal cancer.
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Affiliation(s)
- Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
| | - Katharina Hörmandinger
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
| | - Robert Jäger
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
| | - Sergej Skvortsov
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
| | | | - Martin Maffei
- Department of Radiotherapy, State Hospital of Bolzano, 39100 Bolzano, Italy
| | - Thomas Seppi
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Daniel Dejaco
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Matthias Santer
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Manuel Sarcletti
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
| | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Comprehensive Cancer Center Innsbruck (CCCI), 6020 Innsbruck, Austria
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Choe SI, Lee Y, Habashi R, Samarasinghe Y, Lee MH, McKechnie T, Shargall Y, Finley C, Hanna W, Sur R, Agzarian J. The role of brachytherapy in treatment of stage I esophageal cancer: A systematic review. Brachytherapy 2022; 21:877-886. [PMID: 35941072 DOI: 10.1016/j.brachy.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Despite advancements in the early detection of esophageal cancer, optimal radiotherapy methods for treatment of early disease have not yet been determined. Moreover, the benefit of intraluminal brachytherapy on local control or survival remains controversial. We performed a systematic review to establish the role of brachytherapy as boost therapy in stage I esophageal squamous cell carcinoma, and to evaluate associated survival outcomes. METHODS AND MATERIALS A systematic search of three bibliographic databases from January 1950 to January 2019 was conducted. All studies investigating brachytherapy for curative intent were included and palliative treatment was excluded. Primary outcomes included overall survival and disease-free survival (DFS). Secondary outcomes included loco-regional control (LRC) and toxicity grades and/or complications. Two reviewers independently abstracted data and evaluated study quality using grading of recommendations assessment, development, and evaluation, pooled results were presented through risk ratios. RESULTS A total of 12 retrospective studies met inclusion criteria. The overall quality of evidence yielded a Grade 1C rating (strong recommendation, low quality evidence). Of 525 included patients, 325 patients received both external beam radiation (EBRT), and brachytherapy, 132 underwent EBRT only, and 68 received brachytherapy with and/or without chemoradiation. For patient group treated with EBRT and brachytherapy, 5-year mortality, DFS and LRC were: 43% (27-59%), 63% (49-76%) and 72% (63-80%) respectively. Rates of complications reported included 82.1% Grade 1 esophagitis for a combined external beam radiation and brachytherapy cohort, 12.3% ulcerations, and 3.3% fistulae. CONCLUSIONS Brachytherapy as a combined modality is encouraging, given its relative safety and effectiveness. Further prospective analysis using higher quality evidence is warranted to evaluate oncologic outcomes and survival advantage.
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Affiliation(s)
- Se-In Choe
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Rogeh Habashi
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yasith Samarasinghe
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tyler McKechnie
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christian Finley
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Wael Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ranjan Sur
- Deparment of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada.
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Ye M, Han D, Mao Z, Cheng G. A prospective study of radical external beam radiotherapy versus external beam radiotherapy combined with intraluminal brachytherapy for primary esophageal cancer. Brachytherapy 2022; 21:703-711. [PMID: 35787969 DOI: 10.1016/j.brachy.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/27/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study compared the efficacy and side effects of external beam radiotherapy (EBRT) + intraluminal brachytherapy (IBT) with EBRT alone in patients with primary thoracic esophageal cancer. MATERIALS AND METHODS Between 2013 and 2020, 64 patients with primary thoracic esophageal cancer without surgery received radiotherapy. Thirty-two patients received EBRT + IBT. EBRT dose was 50 Gy, 2 Gy/f, 5 times a week, and IBT dose was 10 Gy, 5 Gy/f, once a week. Thirty-two patients received EBRT alone, and the total dose was 60 Gy. The median followup was 19 months. RESULTS The local control rates (LCR) of EBRT + IBT and EBRT alone group at 1, 2, and 3 years after treatment were 88% and 72%, 53% and 22%, 25%, and 9%, respectively. The overall survival (OS) of the EBRT + IBT and EBRT alone group at 3 years after treatment were 38% and 9%. The 3-year local recurrence-free survival (LRFS) rates of EBRT + IBT and EBRT alone group were 25% and 9%. Univariate analysis showed that EBRT + IBT could be the prognostic factor improving OS (p = 0.04), and tumor located in the mid-thoracic region exhibited a poorer prognosis on LRFS (p = 0.03). Grade 3 or higher acute side effects included two cases of dysphagia and three cases of bone marrow suppression. Severe late side effects included three cases of fistula, three cases of radiation pneumonia, and five cases of stenosis requiring treatment. CONCLUSIONS Compared with EBRT alone, EBRT + IBT is an effective treatment modality for T1∼3NanyM0 primary thoracic esophageal cancer with good local control. It can prolong the survival time of patients and has acceptable toxicity.
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Affiliation(s)
- Mingyue Ye
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dongmei Han
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuang Mao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China.
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The characteristics of oesophageal squamous cell carcinoma: an analysis of 1317 cases in southeastern China. Contemp Oncol (Pozn) 2015; 19:137-41. [PMID: 26034392 PMCID: PMC4444447 DOI: 10.5114/wo.2015.51419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/24/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022] Open
Abstract
AIM OF THE STUDY To research the demographic and histopathological features of ESCC in southeastern China. MATERIAL AND METHODS We retrospectively reviewed the ESCC cases in the biobank of the National Engineering Centre for Biochip in Shanghai, which cooperates with lots of hospitals and research institutions in southeastern China. The patients were pathologically confirmed as having ESCC. The demographic and histopathological features of these cases were analysed subsequently. RESULTS A total of 1317 patients were enrolled. The overall male: female ratio was 2.88: 1. 74.34% of these cases occurred in people aged between 50-70 years. Dysphagia was the most common symptom, which accounted for 93.40% of all the patients. Stage II and III were predominant (79.73%). 72.89% of patients had a tumour length greater than 3 cm. Most of the tumours (65.83%) were located in middle third of the oesophagus. There was a significant difference among the tumour stage, length, and location in different sex groups (P < 0.05), but not between different age groups (P > 0.05). In males, ESCC is usually located in the lower parts, with a longer tumour length and higher tumour stage. 24.15% of patients had lymph nodes ratio (LNR) > 0.2. CONCLUSIONS In our analysis, dysphagia was more common in ESCC patients, to whom more attention should be paid. Additionally, males had a higher incidence, with longer and more distant disease, which gives a poor prognosis.
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Re-evaluating the optimal radiation dose for definitive chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Oncol 2015; 9:1398-405. [PMID: 25122435 DOI: 10.1097/jto.0000000000000267] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal radiation dose for treating esophageal squamous cell carcinoma (ESCC) has long been debated. We evaluated if doses greater than 50.4 Gy delivered with modern techniques are beneficial in terms of tumor control, survival, and toxicity. METHODS We included 193 consecutive patients with ESCC treated with definitive concurrent chemoradiotherapy from 1998 to 2012. Patients were treated to a dose of ≤50.4 Gy (low-dose, n = 137) or greater than 50.4 Gy (high-dose, n = 56). Tumor response, local-regional control, survival, and treatment toxicity were compared between groups. RESULTS High-dose group had a significantly lower local failure rate (17.9% versus 34.3%, p = 0.024) and a marginal better 5-year local-regional failure-free survival (68.7% versus 55.9%, p = 0.052) than the low-dose group. No significant differences were found between high- and low-dose groups in tumor complete response rate (p = 0.975), regional failure rate (p = 0.336), distant metastasis rate (p = 0.390), or 5-year overall survival (p = 0.617). No difference in the incidence of toxic effects was observed between the two groups except for grade 3 skin reaction (12.5% [high] versus 2.2% [low], p < 0.001) and grade greater than or equal to 3 esophageal stricture (32.1% [high] versus 18.2% [low], p = 0.037). CONCLUSIONS Local tumor control might be improved by higher dose of greater than 50.4 Gy, when delivered with modern techniques and concurrent chemotherapy, at the consequence of increased toxicity without impact on overall survival.
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Rovirosa Á, Anchuelo J, Crispin V, Gutiérrez C, Herreros A, Herruzo I, Menéndez JC, Pino P, Polo A, Rodríguez S. Recommendations of the Spanish Brachytherapy Group of SEOR for HDR endoluminal treatments. Part 1: Oesophagus. Clin Transl Oncol 2015; 17:581-9. [DOI: 10.1007/s12094-015-1284-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022]
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Park I, Kim YH, Yoon DH, Park SR, Kim HR, Kim JH, Jung HY, Lee GH, Cho KJ, Kim SB. Non-surgical treatment versus radical esophagectomy for clinical T1N0M0 esophageal carcinoma: a single-center experience. Cancer Chemother Pharmacol 2014; 74:995-1003. [PMID: 25190176 DOI: 10.1007/s00280-014-2573-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/21/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Inkeun Park
- Department of Oncology, Esophageal Cancer Study Group (ECSG), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul, 138-736, Korea
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Shimizu M, Zaninotto G, Nagata K, Graham DY, Lauwers GY. Esophageal squamous cell carcinoma with special reference to its early stage. Best Pract Res Clin Gastroenterol 2013; 27:171-86. [PMID: 23809239 DOI: 10.1016/j.bpg.2013.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/08/2013] [Indexed: 02/07/2023]
Abstract
The term 'early squamous cell carcinoma of the oesophagus', which was previously restricted to superficial carcinoma with no lymph node metastasis, now encompasses intramucosal carcinoma regardless of the nodal status. Such lesions are rare in Western countries, where the experience is limited. In recent years, the development and greater use of chromoendoscopy and narrow band imaging (NBI), both of which facilitate the evaluation of mucosal morphology, have played an important role in the detection of early esophageal squamous cell carcinoma. In addition, the techniques and indications of endoscopic resection (mucosal resection [EMR] and mucosal dissection [ESD]) are still being refined. In the present article, we will discuss the clinical and pathologic features of esophageal early squamous cell carcinoma, as well as the epidemiology and aetiology of esophageal cancer in general. In addition, we will provide a therapeutic decision tree taking into account endoscopic and surgical modalities as they apply to early esophageal squamous cell carcinoma.
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Affiliation(s)
- Michio Shimizu
- Department of Pathology, Saitama Medical University, Saitama International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan.
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Chen SB, Weng HR, Wang G, Yang JS, Yang WP, Liu DT, Chen YP, Zhang H. Surgical treatment for early esophageal squamous cell carcinoma. Asian Pac J Cancer Prev 2013; 14:3825-30. [PMID: 23886190 DOI: 10.7314/apjcp.2013.14.6.3825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
More studies are needed to clarify treatments and prognosis of early esophageal squamous cell carcinoma (ESCC). This retrospective study was designed to review the outcome of surgical treatment for early ESCC, evaluate the results of a left thoracotomy for selected patients with early ESCC, and identify factors affecting lymph node metastases and survival. The clinicopathological data of 228 patients with early ESCC who underwent transthoracic esophagectomy with lymphadenectomy without preoperative adjuvant treatment were reviewed. The χ(2) test or Fisher's exact test were used to detect factors related to lymph node metastasis. Univariate and multivariate analyses were performed to identify prognostic factors. There were 152 males and 76 females with a median age of 55 years. Two hundred and eight patients underwent a left thoracotomy, and the remaining 20 patients with lymph nodes in the upper mediastinum more than 5 mm in short-axis diameter by computed tomography scan underwent a right thoracotomy. No lymph node metastasis was found in the 18 patients with carcinoma in situ, while lymph node metastases were detected in 1.6% (1/62) of patients with mucosal tumours and 18.2% (27/148) of patients with submucosal tumours. Only 7 patients showed upper mediastinal lymph node metastases in the follow-up. The 5- and 10-year overall survival rates were 81.4% and 70.1%, respectively. Only histologic grade (P<0.001) and pT category (P=0.001) significantly correlated with the presence of lymph node metastases. In multivariate analysis, only histologic grade (P=0.026) and pT category (P=0.008) were independent prognostic factors. A left thoracotomy is acceptable for selected patients with early ESCC. Histologic grade and pT category affected the presence of lymph node metastases and were independent prognostic factors for early ESCC.
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Affiliation(s)
- Shao-Bin Chen
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Guangdong, China
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Semrau R, Herzog SL, Vallböhmer D, Kocher M, Hölscher AH, Müller RP. Prognostic factors in definitive radiochemotherapy of advanced inoperable esophageal cancer. Dis Esophagus 2012; 25:545-54. [PMID: 22133297 DOI: 10.1111/j.1442-2050.2011.01286.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to assess the efficacy and prognostic factors of definitive radiochemotherapy (RCT) for inoperable esophageal cancer. Between 1995 and 2005 all patients with inoperable esophageal cancer that underwent concurrent RCT were included in this retrospective study. Conventional computed tomography-based treatment planning as well as 3D-conformal radiotherapy (RT) was used. Maximum radiotherapy dose was 63 Gy. Chemotherapy consisted of cisplatin (20 mg/m(2) d1-5 and 29-33) and 5-FU (650-1000 mg/m(2) d1-5 and 29-33). Patients not suitable for RCT received radiotherapy alone. Toxicity was measured according to common toxicity criteria (CTC). Two hundred three consecutive patients with inoperable esophageal cancer that received definitive therapy were identified in this time period (160 with squamous cell carcinoma and 43 with adenocarcinoma). The 2-year overall survival probability was 21.2% whereas the progression-free survival at 2 years was 13.8% for all patients. In the univariate analysis, type of histology, T-stage, N-stage, application of chemotherapy, and the radiation dose were significantly correlated with overall/progression-free survival. Moreover, multivariate analysis revealed an independent prognostic impact for N-stage, radiation dose, and concurrent chemotherapy. Definitive RCT is an important palliative treatment option for patients with inoperable esophageal cancer. N-stage, radiation dose, and concurrent chemotherapy are important prognostic factors for survival.
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Affiliation(s)
- R Semrau
- Department of Radiation Oncology, University of Cologne, Cologne, Germany.
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Muijs CT, Beukema JC, Mul VE, Plukker JT, Sijtsema NM, Langendijk JA. External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma. Radiother Oncol 2012; 102:303-8. [DOI: 10.1016/j.radonc.2011.07.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 07/26/2011] [Accepted: 07/26/2011] [Indexed: 11/16/2022]
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13
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Song YP, Ma JB, Hu LK, Zhou W, Chen EC, Zhang W. Phase I/II study of hypofractioned radiation with three-dimensional conformal radiotherapy for clinical T3-4N0-1M0 stage esophageal carcinoma. Technol Cancer Res Treat 2011; 10:25-30. [PMID: 21214285 DOI: 10.7785/tcrt.2012.500176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Compared to conventional fractionated-dose radiotherapy, high hypofractionated-dose radiotherapy could yield tumoricidal effects. However, few clinical trials of hypofractionated radiotherapy in loco-regionally advanced incurable esophageal cancer at present have yet been performed. The purpose of the current study was to evaluate the efficacy and toxicity of hypofractioned radiation with three-dimensional conformal radiotherapy for clinical T3-4N0-1M0 stage esophageal carcinoma. From September 2003 to December 2005, 45 patients with locally advanced esophageal carcinoma were grouped and received three-dimensional conformal hypofractioned radiotherapy (3D-CRT) whose fractionated dose was gradually increase per group. Radiotherapy was administered to a total dose of from 50 to 54 Gy (fractionated dose of from 3.0 to 6.0 Gy, 3 times weekly), over a 3-4 week period. And patients received 4 cycles chemotherapy. The median follow-up period for survivors was 38 months. Treatment tolerance rate was 78.8% with daily dose of from 3 to 5 Gy. There are 21.2% patients occurring Grade ≥ 3 acute toxicities. But patients couldn't tolerate daily dose of 6 Gy (55.6%). The 1-year, 2-year and 3-year local control rates were 62%, 49% and 39% respectively. And the 1-year, 2-year and 3-year overall survival rates were 34%, 21% and 9% respectively. The median overall survival time was 17 months. At the time of following up, 13 patients (31.0%) had occurred esophageal late complications, with mainly esophageal perforation, hemorrhage or stenosis, including initial stenosis aggravation. Therefore hypofractionated irradiation was thought to be feasible for clinical T3-4N0-1M0 stage esophageal carcinoma. And daily dose of ≤5 Gy was comparatively suitable in hypofractionated irradiation for esophageal carcinoma, and the patients tolerated well. But further research was in need also.
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Affiliation(s)
- Y-P Song
- Department of Radiation Oncology, Qilu Hospital, Shandong University, 44# Wenhua Xi Road, Ji'nan, Shandong, 250012, PR China
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Long-term outcomes of intraluminal brachytherapy in combination with external beam radiotherapy for superficial esophageal cancer. Int J Clin Oncol 2011; 17:263-71. [DOI: 10.1007/s10147-011-0285-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 06/24/2011] [Indexed: 01/02/2023]
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Tamaki T, Ishikawa H, Takahashi T, Tamaki Y, Kitamoto Y, Okamoto M, Noda SE, Katoh H, Shirai K, Sakurai H, Nakano T. Comparison of efficacy and safety of low-dose-rate vs. high-dose-rate intraluminal brachytherapy boost in patients with superficial esophageal cancer. Brachytherapy 2011; 11:130-6. [PMID: 21700506 DOI: 10.1016/j.brachy.2011.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/23/2011] [Accepted: 05/23/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the efficacy and the incidence of complications of high-dose-rate (HDR) and low-dose-rate (LDR) intraluminal brachytherapy (IBT) boost after external beam radiation therapy in patients with superficial esophageal cancer. METHODS AND MATERIALS Fifty-four consecutive patients with Stage I thoracic esophageal squamous cell carcinoma who were treated with definitive radiotherapy using IBT between 1991 and 2007 were studied retrospectively. LDR-IBT and HDR-IBT were performed for 19 and 35 patients, respectively. After external beam radiation therapy of 56-60 Gy with a conventional fractionation, LDR-IBT (5 Gy × 2) or HDR-IBT (3 Gy × 3) was given within 2 weeks. The median follow-up was 47 months (7-151 months). RESULTS Overall, the 5-year overall survival, cause-specific survival (CSS), and locoregional control (LRC) rates were 61%, 86%, and 79%, respectively. The 5-year overall survival, CCS, and LRC rates did not differ significantly between the LDR-IBT and HDR-IBT groups (68% vs. 58% (p=0.50), 83% vs. 85% (p=0.63), and 84% vs. 75% (p=0.42), respectively). Salvage treatment was given in 8 locally recurrent patients, and 6 patients were rescued. The Grade ≥2 late morbidities of esophagus and heart/lung were observed in 5 patients (4 in the LDR-IBT group and 1 in the HDR-IBT group) and 2 patients (one from each group), respectively. CONCLUSIONS In view of the safety profile and effectiveness, our results encourage the continued adoption of HDR-IBT as radiation boost in medically inoperable or elderly superficial esophageal cancer patients undergoing definitive radiotherapy.
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Affiliation(s)
- Tomoaki Tamaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer. Surg Endosc 2010; 24:870-8. [PMID: 19730945 DOI: 10.1007/s00464-009-0681-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 08/08/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study aimed to assess the prognostic significance of endoluminal ultrasound-defined total length of disease and endoluminal ultrasound defined tumor volume (EDTV) in esophageal cancer. The hypothesis was that endoscopic ultrasound (EUS)-defined total length of disease and EDTV are both significant prognostic indicators and better predictors of outcome than endoscopic tumor length. METHODS In this study, 174 consecutive patients (median age, 64 years and 128 months) underwent specialist EUS, and the maximum potential EDTV was calculated (pir(2) L, where r is the tumor thickness and L is the total length of disease) including proximal and distal lymph node metastases. Of the 174 patients, 104 underwent surgery (70 had neoadjuvant chemotherapy), 60 underwent definitive chemoradiotherapy, and 10 had palliative therapy. RESULTS Survival was related to EUS T stage (p = 0.013), EUS N stage (p = 0.001), EUS M1a stage (p = 0.004), EUS disease length (<8 cm; p = 0.001), and EDTV (all patients <25 cm(3), p = 0.001; surgical patients <40 cm(3), p = 0.036). Forward conditional multivariate analysis showed three factors to be associated with survival: EUS N stage (hazard ratio [HR], 1.646; 95% confidence interval [CI], 1.041-2.602; p = 0.033), EUS M1a stage (HR, 2.702; 95% CI, 1.069-6.830; p = 0.036), and EDTV (HR, 2.702; 95% CI, 1.069-6.830; p = 0.025). Median and 2-year survival for EDTV <25 cm(3) versus >25 cm(3) was 43.4 months and 56%, respectively, compared with 23.5 months and 35%. CONCLUSIONS In this study, EDTV based on total EUS-defined length of disease emerged as a new and important prognostic indicator for patients with esophageal cancer.
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The safety and effectiveness of endoscopic and non-endoscopic approaches to the management of early esophageal cancer: a systematic review. Cancer Treat Rev 2010; 37:11-62. [PMID: 20570442 DOI: 10.1016/j.ctrv.2010.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/13/2010] [Accepted: 04/25/2010] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Traditionally, management of early cancer (stages 0-IIA) has comprised esophagectomy, either alone or in combination with chemotherapy and/or radiotherapy. Recent efforts to improve outcomes and minimize side-effects have focussed on minimally invasive, endoscopic treatments that remove lesions while sparing healthy tissue. This review assesses their safety and efficacy/effectiveness relative to traditional, non-endoscopic treatments for early esophageal cancer. METHODS A systematic review of peer-reviewed studies was performed using Cochrane guidelines. Bibliographic databases searched to identify relevant English language studies published in the last 3 years included: PubMed (i.e., MEDLINE and additional sources), EMBASE, CINAHL, The Cochrane Library, the UK Centre for Reviews and Dissemination (NHS EED, DARE and HTA) databases, EconLit and Web of Science. Web sites of professional associations, relevant cancer organizations, clinical practice guidelines, and clinical trials were also searched. Two independent reviewers selected, critically appraised, and extracted information from studies. RESULTS The review included 75 studies spanning 3124 patients and 10 forms of treatment. Most studies were of short term duration and non-comparative. Adverse events reported across studies of endoscopic techniques were similar and less significant compared to those in the studies of non-endoscopic techniques. Complete response rates were slightly lower for photodynamic therapy (PDT) relative to the other endoscopic techniques, possibly due to differences in patient populations across studies. No studies compared overall or cause-specific survival in patients who received endoscopic treatments vs. those who received non-endoscopic treatments. DISCUSSION Based on findings from this review, there is no single "best practice" approach to the treatment of early esophageal cancer.
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Sillah K, Williams LR, Laasch HU, Saleem A, Watkins G, Pritchard SA, Price PM, West CM, Welch IM. Computed tomography overestimation of esophageal tumor length: Implications for radiotherapy planning. World J Gastrointest Oncol 2010; 2:197-204. [PMID: 21160598 PMCID: PMC2999183 DOI: 10.4251/wjgo.v2.i4.197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the relationship between preoperative computed tomography (CT) and postoperative pathological measurements of esophageal tumor length and the prognostic significance of CT tumor length data.
METHODS: A retrospective study was carried out in 56 patients who underwent curative esophagogastrectomy. Tumor lengths were measured on the immediate preoperative CT and on the post-operative resection specimens. Inter- and intra-observer variations in CT measurements were assessed. Survival data were collected.
RESULTS: There was a weak correlation between CT and pathological tumor length (r = 0.30, P = 0.025). CT lengths were longer than pathological lengths in 68% (38/56) of patients with a mean difference of 1.67 cm (95% CI: 1.18-2.97). The mean difference in measurements by two radiologists was 0.39 cm (95% CI: -0.59-1.44). The mean difference between repeat CT measured tumor length (intra-observer variation) were 0.04 cm (95% CI: -0.59-0.66) and 0.47 cm (95% CI: -0.53-1.47). When stratified, patients not receiving neoadjuvant chemotherapy showed a strong correlation between CT and pathological tumor length (r = 0.69, P = 0.0014, n = 37) than patients that did (r = 0.13, P = 0.43, n = 19). Median survival with CT tumor length > 5.6 cm was poorer than with smaller tumors, but the difference was not statistically significant.
CONCLUSION: Esophageal tumor length assessed using CT does not reflect pathological tumor extent and should not be the only modality used for management decisions, particularly for planning radiotherapy.
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Affiliation(s)
- Karim Sillah
- Karim Sillah, Ian M Welch, Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
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Ishikawa H, Nonaka T, Sakurai H, Tamaki Y, Kitamoto Y, Ebara T, Shioya M, Noda SE, Shirai K, Suzuki Y, Takahashi T, Nakano T. Usefulness of Intraluminal Brachytherapy Combined With External Beam Radiation Therapy for Submucosal Esophageal Cancer: Long-Term Follow-Up Results. Int J Radiat Oncol Biol Phys 2010; 76:452-9. [DOI: 10.1016/j.ijrobp.2009.02.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 02/06/2009] [Accepted: 02/07/2009] [Indexed: 11/25/2022]
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Muramoto T, Kaneko K, Kuroki A, Konishi K, Ito H, Katagiri A, Kubota Y, Ohtsu A, Imawari M. Causal relationships between esophageal squamous cell carcinoma and nephrotic syndrome. Intern Med 2009; 48:65-9. [PMID: 19122359 DOI: 10.2169/internalmedicine.48.1292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present a case of membranous nephropathy (MN) associated with esophageal squamous cell carcinoma (ESCC) with a high serum level of squamous cell carcinoma antigen (SCC). ESCC reached complete response (CR) for radiotherapy, with a partial remission of the proteinuria and decreased serum SCC levels. Six months after radiotherapy, the ESCC recurred, and the patient was treated with endoscopic mucosal resection (EMR), achieving a pathologic CR and disappearance of proteinuria and normalized serum SCC levels. The correlation of proteinuria and the serum level of SCC indicates that SCC could be a pathogenic antigen, responsible for the pathogenesis of MN in this patient.
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Affiliation(s)
- Takashi Muramoto
- The Second Department of Internal Medicine, Showa University School of Medicine, Tokyo
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21
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Buchmann I, Haberkorn U, Schmidtmann I, Brochhausen C, Buchholz HG, Bartenstein P, Hansen T. Influence of cell proportions and proliferation rates on FDG uptake in squamous-cell esophageal carcinoma: a PET study. Cancer Biother Radiopharm 2008; 23:172-80. [PMID: 18454686 DOI: 10.1089/cbr.2007.349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We investigated the influence of cell proportions and proliferation activities on tumor maximum standard uptake value (SUV(max)) in patients with squamous-cell esophageal cancer (SCEC). METHODS Sixteen (16) patients with untreated SCEC were examined with (18)F-flourodeoxyglucose positron emission tomography (FDG-PET). The tumor SUV(max) were calculated. Tumors were resected by transthoracic esophagectomy. Tissues were stained with hematoxylin and eosin for the measurement of cell proportions and MIB-1 for measurement of proliferation indices (PIs). Tumor SUV and histologic data were related by using multiple linear regression analysis. RESULTS The mean proportion of tumor cells in the tumor site was 58.1% (+/-12.1%); the proportion of inflammatory cells was 34.2% (+/-14.2%); the PI of tumor cells was 70.5% (+/-11.8%); and the PI of inflammatory cells was 22.2% (+/-7.6%). The tumor PI was the only variable that was significantly associated with the FDG uptake in the tumor site (p = 0.04). The correlation was low (Pearson-coefficient Gamma = 0.51). The Pearson-correlation-coefficient between tumor SUV and the fraction of inflammatory cells was Gamma = 0.37 and between tumor SUV and PI of inflammatory cells Gamma = 0.13. CONCLUSIONS In untreated SCEC-patients, the tumor maximum FDG uptake is weakly associated with the proliferation rate of tumor cells. In contrast, neither the proportion nor the PI of inflammatory cells in the tumor site significantly correlates with the maximum SUV and should not profoundly affect PET interpretations.
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Affiliation(s)
- Inga Buchmann
- Klinik und Poliklinik für Nuklearmedizin, Universitätskliniken Mainz, Mainz, Germany.
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Treatment outcomes of radiotherapy for patients with stage I esophageal cancer: a single institute experience. Am J Clin Oncol 2007; 30:514-9. [PMID: 17921713 DOI: 10.1097/coc.0b013e31805c1410] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of radiotherapy for patients with stage I esophageal cancer. METHODS From 1995 to 2005, 34 patients with superficial thoracic esophageal squamous cell carcinoma without lymph node metastasis were treated with radiotherapy at our institute. Patient characteristics were as follows: median age, 68 years; range, 47 to 84 years; male:female, 33:1; performance status, 0/1/2/3 = 23/9/1/1; T1a/T1b = 4/30. Median fraction and total doses of external irradiation given were 2.0 Gy and 60 Gy, respectively. Twenty-three patients had local irradiation to the primary lesion only; the remaining 11 patients received regional field irradiation, including one or 2 regional lymph node areas. Only one patient received adjuvant intracavitary radiotherapy after radiotherapy. Thirty of the patients received concurrent chemotherapy, most of the regimens of which included cisplatin and 5-fluorouracil. Adjuvant chemotherapy was performed in 5 patients. Fifteen patients (44%) had coexisting malignancies. The median follow-up was 38 months (range, 8-107 months). RESULTS The 5-year overall, cause-specific, and local-progression-free survival rates were 50.4%, 91.2%, and 81.1%, respectively. Of the 34 patients, 6 had in-field local recurrence, and one had recurrence in the esophagus outside of the irradiated field. Two patients experienced regional lymph node metastasis outside of the irradiated field, and one had distant metastasis. Two patients received salvage surgery, and 4 patients received salvage intracavitary radiotherapy after local recurrence. A late toxicity greater than grade 2 was not observed in any patient. CONCLUSIONS Radiotherapy is an effective treatment modality for patients with stage I esophageal cancer.
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Kim JH, Chung HS, Youn YH, Park SW, Song SY, Chung JB, Kim CB, Lee YC. Treatment outcomes of 70 cases of early esophageal carcinoma: 12 years of experience. Dis Esophagus 2007; 20:297-300. [PMID: 17617877 DOI: 10.1111/j.1442-2050.2007.00674.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Early esophageal cancer (EEC) has an excellent prognosis compared to advanced esophageal cancer. Nowadays, endoscopic mucosal resection (EMR) may offer another alternative to cure early cancers of the gastrointestinal tract. We aimed to evaluate the clinical outcomes of EEC in Korea after curative treatments; EMR or surgery. We retrospectively reviewed the medical records of patients diagnosed as EEC from January 1994 to August 2005 at Yonsei University Medical Center, Seoul, Korea. Among 888 patients diagnosed with esophageal cancer, 70 (7.9%) were included as EEC. Among them, 10 patients (14.3%) were treated by EMR, and 50 (71.4%) by operation. The treatment outcomes of EEC in relation to various clinicopathologic factors along with survival rates were analyzed. There were 18 cases (30%) of mucosal lesions and 42 cases (70%) of submucosal lesions. Overall 5-year survival rate was 84.3%. When comparing treatment outcomes between EMR-treated and operated groups, there were no significant differences in complete remission (80%vs. 84%), recurrence (20%vs. 16%) and 5-year survival rate (100%vs. 78.3%). EEC is a potentially curable entity with a good clinical prognosis. EMR can be considered as another treatment arm for EEC, along with surgical resection.
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Affiliation(s)
- J-H Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul 120-752, Korea
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Ugur VI, Kara SP, Kucukplakci B, Demirkasimoglu T, Misirlioglu C, Ozgen A, Elgin Y, Sanri E, Altundag K, Ozdamar N. Clinical characteristics and outcome of patients with stage III esophageal carcinoma: a single-center experience from Turkey. Med Oncol 2007; 25:63-8. [DOI: 10.1007/s12032-007-0043-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 06/22/2007] [Indexed: 01/30/2023]
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Abstract
Radiation plays an important role in the treatment of thoracic tumors. During the last 10 years there have been several major advances in thoracic RT including the incorporation of concurrent chemotherapy and the application of con-formal radiation-delivery techniques (eg, stereotactic RT, three-dimensional conformal RT, and intensity-modulated RT) that allow radiation dose escalation. Radiation as a local measure remains the definitive treatment of medically inoperable or surgically unresectable disease in NSCLC and part of a multimodality regimen for locally advanced NSCLC, limited stage SCLC, esophageal cancer, thymoma, and mesothelioma.
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Affiliation(s)
- Feng-Ming Spring Kong
- Department of Radiation Therapy, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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